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Pediatric Intestinal and Multivisceral Transplantation Workup

  • Author: Seigo Nishida, MD, PhD; Chief Editor: Stuart M Greenstein, MD  more...
 
Updated: Jan 06, 2016
 

Laboratory Studies

See the list below:

  • Perform an automated cell count (ACC) and platelet (Plt) count to rule out anemia and thrombocytopenia.
  • Assess electrolyte levels to look for electrolyte imbalance caused by short bowel syndrome.
  • Perform liver function tests to rule out cholestatic liver failure and evaluate liver function.
    • Serum glutamic-oxaloacetic transaminase (SGOT, aspartate aminotransferase) test
    • Serum glutamic-pyruvic transaminase (SGPT, alanine aminotransferase) test
    • Alkaline phosphatase (ALKP) test
    • Glucose tolerance test (GTTP)
  • Measure prothrombin time (PT) and activated partial thromboplastin time (aPTT) to rule out coagulation abnormalities and evaluate liver function.
  • Perform coagulation studies to rule out the cause of thrombosis.
    • Protein C deficiency study
    • Protein A deficiency study
    • Factor deficiency study
    • Vitamin study
  • Perform urinalysis to evaluate renal function and rule out infection.
  • Assess creatine clearance to evaluate renal function.
  • Perform a culture to rule out infection.
  • Assess vitamin levels to evaluate nutrition.
  • Perform an absorption test to evaluate intestinal function.
  • Donor specific antibodies (DSA) are evaluated to quantify the sensitaization.
  • Citrulline levels are measured to monitor the condition of the intestine.
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Imaging Studies

See the list below:

  • Doppler ultrasonography of the extremities to assess the patency of the vein
  • Doppler ultrasonography of the liver to assess the patency of the vessel
  • CT scanning of the abdomen
  • Upper GI series with small bowel follow-through
  • Angiography of the abdomen
  • Upper GI endoscopy
  • MRI
  • Magnetic resonance angiography
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Other Tests

See the list below:

  • Echocardiography
  • Stress echocardiography
  • Nuclear medicine studies
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Diagnostic Procedures

See the list below:

  • Biopsy of the intestine for pathological diagnosis (if indicated): If intestinal failure is functional, the diagnosis depends on the pathological findings and exclusion. Biopsy of the intestine is necessary for the final diagnosis. Perform case-by-case evaluations.
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Histologic Findings

See the list below:

  • See Diagnostic Procedures.
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Contributor Information and Disclosures
Author

Seigo Nishida, MD, PhD Professor of Clinical Surgery, Miami Transplant Institute, Department of Surgery, University of Miami, Leonard M Miller School of Medicine

Seigo Nishida, MD, PhD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Society for Surgery of the Alimentary Tract, Society of University Surgeons, Transplantation Society, Japan Surgical Society

Disclosure: Nothing to disclose.

Coauthor(s)

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Andreas G Tzakis, MD, PhD Professor of Surgery

Andreas G Tzakis, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Angiology, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Spinal Injury Association, International College of Surgeons, Society of University Surgeons

Disclosure: Nothing to disclose.

Tomoaki Kato, MD Associate Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Miller School of Medicine, University of Miami

Tomoaki Kato, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, American Society of Transplant Surgeons

Disclosure: Nothing to disclose.

David M Levi, MD Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Division of General Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami

David M Levi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Study of Liver Diseases, American College of Surgeons, American Society of Transplant Surgeons, Phi Beta Kappa, International Liver Transplantation Society, Transplantation Society

Disclosure: Nothing to disclose.

Jose R Nery, MD Medical Director, Good Samaritan Community Health Care Center

Jose R Nery, MD is a member of the following medical societies: American Society of Transplant Surgeons, International Liver Transplantation Society, Transplantation Society

Disclosure: Nothing to disclose.

Juan Madariaga, MD 

Juan Madariaga, MD is a member of the following medical societies: American Medical Association, American Society of Transplant Surgeons, Medical Society of the State of New York, Society of Surgical Oncology

Disclosure: Nothing to disclose.

Phillip Ruiz, Jr, MD, PhD Professor of Pathology, Department of Pathology and Surgery, Miller School of Medicine, University of Miami

Phillip Ruiz, Jr, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American Society for Clinical Pathology, American Society of Nephrology, American Society of Transplant Surgeons, American Society of Transplantation, Clinical Immunology Society, Florida Medical Association, New York Academy of Sciences, Pan America Medical Association of Central Florida, Southern Medical Association, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian F Gilchrist, MD Surgeon-in-Chief of Pediatric Surgery, The Floating Hospital for Children at Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine

Brian F Gilchrist, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Chief Editor

Stuart M Greenstein, MD Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center

Stuart M Greenstein, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, International College of Surgeons, Medical Society of New Jersey, National Kidney Foundation, New York Academy of Sciences, Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Additional Contributors

Casimir F Firlit, MD, PhD Director of Reconstructive Urology, Neuro-Urology and Fetal Urology at SSM Cardinal Glennon Children's Medical Center.

Casimir F Firlit, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Urological Association, Illinois State Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

John F Thompson, MD Professor of Pediatrics, Director of Division of Pediatric Gastroenterology and Nutrition, University of Miami Miller School of Medicine

John F Thompson, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Acknowledgments

The authors gratefully acknowledge Jose Martinez, MD, for his support involving endoscopy and patient care. The authors also acknowledge Joseph Tector, MD, for his support of this manuscript. The authors would also like to thank Debbie Weppler, RN, for her contribution of intestinal patient management and data collection.

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Isolated intestine transplantation.
Liver and intestine transplantation.
Liver, intestine, and pancreas transplantation.
Multivisceral transplantation.
Endoscopic view of small-bowel graft is shown. Views A and D are normal; views B and E show moderate rejection; and views C and F indicate severe rejection.
Number of transplants.
Intestinal transplantation in adult and pediatric patients.
Donor age.
Patient survival of isolated intestinal transplantation.
Patient survival of 3 types of intestinal transplantation.
 
 
 
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